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Case Reports
. 2022 Mar;21(1):93-98.
doi: 10.1007/s12663-021-01545-w. Epub 2021 Mar 13.

Endoscopic Endonasal Surgery for a Pterygopalatine Fossa Hydatid Cyst

Vjerislav Peterković  1 , Marcel Marjanović Kavanagh  2 , Hrvoje Barić  1 , Niko Njirić  1 , Mirjana Balen-Topić  3 , Relja Beck  4 , Klaudija Višković  3
Affiliations
Case Reports

Endoscopic Endonasal Surgery for a Pterygopalatine Fossa Hydatid Cyst

Vjerislav Peterković et al. J Maxillofac Oral Surg. 2022 Mar.

Abstract

Background: Cystic echinococcosis is a manifestation of a zoonosis caused by larvae of the tapeworm Echinococcus granulosus sensu lato and pterygopalatine fossa cases are extremely rare.

Clinical presentation and findings: A 45-year-old Caucasian female with a history of repeated surgeries for HC was referred to our center for treatment of a cystic mass of the pterygopalatine fossa. Multiorgan dissemination was noted on preoperative imaging.

Interventions: An endonasal endoscopic procedure was carried over under general anesthesia and the CE completely removed. Etiology was confirmed by molecular diagnostics. Three weeks after the skull base procedure, the patient underwent a combined abdominal/urological procedure for treatment of other cysts.

Conclusion: This case shows that the pterygopalatine fossa HC are amenable to surgical treatment using the endonasal endoscopic approach. Extensive preoperative workup is essential to assess the extent of the disease.

Keywords: Echinococcus granulosus sensu stricto; Endonasal; Endoscopy; Hydatid cyst.

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Figures

Fig. 1
Fig. 1
Timeline of surgical procedures. HC—hydatid cyst; ABZ—albendazole; NS—neurosurgical procedure; PHB—phenobarbital; SRS—stereotactic radiosurgery; ES—endoscopic surgery; PZQ—praziquantel
Fig. 2
Fig. 2
Preoperative CT of the abdomen. Cystic lesions are seen in the liver (a), left kidney (b) and mesentery (c)
Fig. 3
Fig. 3
Pre- and postoperative brain MRI. Preoperative T2-weighted axial image showing a multicystic lesion in the temporopolar region (a) extending into the pterygopalatine fossa, as seen on the coronal image (b). Postoperative T2-weighted axial (c) and coronal (d) images
Fig. 4
Fig. 4
Intraoperative view. (a) Aspiration of the HC located in the pterygopalatine fossa with two suction tubes (b). View of the empty cyst after irrigation with 10% NaCl solution—temporal pole (*), 2nd (**) and 3rd (***) branch of the trigeminal nerve exposed in the field (b). (c) Nasoseptal flap placed over the empty cyst covered with oxidized regenerated cellulose (c). Endoscopic view at three months postoperatively (d), endoscopic view 3 months post-surgery, showing the nasoseptal flap in situ covering the content of the pterygopalatine fossa, widely opened maxillary and sphenoid sinus
See this image and copyright information in PMC

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